0025 : Myocardial revascularization modalities in 200 patients with venous coronary artery bypass graft failure

Abstract

The therapeutic management of bypass failure has been little studied. Compare prognosis and the occurrence of cardiovascular events at 2 years in patients with venous bypass graft failure by differentiating between three patient groups: medical therapy, percutaneous coronary intervention (PCI) in native vessels (native PCI), and PCI in coronary artery bypass grafts (PCI-CABG). Retrospective observational study in patients with bypass graft failure diagnosed between February 2009 and September 2013 at Poitiers University Hospital, France. Follow-up data at 1 year and at 2 years regarding major adverse cardiac events (MACEs), defined as death, acute coronary syndrome (ACS) or revascularization, were collected during patient visits to the department. From a series of 320 CABG patients examined using coronary angiography, all patients with bypass graft failure were included in the study (200 patients). Mean age was 69 years (+/- 11). Coronary angiography was performed a mean of 117 months after bypass surgery. Medical therapy alone was chosen in 88 patients, 75 patients underwent native PCI, and 37 patients underwent PCI-CABG. Patients in the PCI-CABG group were older (73.6 years; p = 0.027) and had significantly older bypass grafts (22% for a period of more than 10 years; p = 0.018), and their typical clinical presentation was one of ACS without ST-segment elevation (41%; p = 0.006). The groups were comparable in terms of hospital complications, except for vascular complications, which were more common in the PCI-CABG group (8%; p =0.01). At 1 year, no significant difference in terms of MACEs was found, but there was a trend towards an increase in ACS without ST-segment elevation (11%; p =0.06) in the PCI-CABG group, and towards an increase in ACS with STsegment elevation (7%; p = 0.06) in the medical therapy group. At 2 years, the medical therapy group stood out by virtue of a significant increase in MACEs compared with the other two groups (63%; p = 0.02). The native PCI group presented both fewer MACEs and fewer vascular complications. MACEs were common and more severe in the medical therapy group. When coronary lesions are amenable to PCI, PCI in native vessels should be proposed as first-line treatment. PCI of CABG is performed in a riskier setting and has poorer prognosis.